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SHARP Area 3: SMART (Substitutable Medical Apps) Josh C. Mandel, MD Joshua.Mandel@childrens.harvard.edu Lead Architect, SMART (http://smartplatforms.org) Research Faculty, Harvard Medical School Sharp Area 4 Face-to-face, July 1 2011
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SMART goals Health IT users work with installable, substitutable apps Health IT systems benefit from efficient marketplace of apps vibrant developer community
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Why substitutable apps? Improved user experience More integrated innovation Case study: Wired competition
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Why substitutable apps? Improved user experience More integrated innovation Case study: Wired competition
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Why substitutable apps? David McCandless & Stefanie Posavec for Wired Magazine informationisbeautiful.net
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Vocabulary Apps Containers API
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Vocabulary Containers Apps API
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A Substitutable App Your system here. SMART Reference EMR Indivo PCHR i2b2
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Vocabulary Containers Apps API
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SMART $5K Challenge
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An app runs against one container (at a time) A container connects to multiple data sources Apps and containers
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SMART components
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Web standards! Apps can run on separate servers, different implementation stacks Inspired by Web APIs Facebook, OpenSocial, Google
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Data Context, Medical Record Elements UI Standards-based integration, flexibility Authentication In-browser, server-to-server Apps need (at least!)
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Contextual data (patient, physician) low-hanging fruit Medical data (blood pressure, cholesterol) existing standards? pragmatic approaches? Apps need data!
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Open standards?
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CCR: “Licensee may access and download an electronic file of a Document (or portion of a Document) for temporary storage on one computer for purposes of viewing, and/or printing one copy of a Document for individual use. Neither the electronic file nor the single hard copy print may be reproduced in any way.” Open standards?
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Intuitive payload?
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What’s practical? PCHRs provide practical data models Indivo http://wiki.indivohealth.org/index.php/Indivo_Document_Model MS HealthVault Data Types: http://developer.healthvault.com/types/types.aspx Google Health Subset of CCR: http://code.google.com/apis/health/ccrg_reference.html
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SMART data 80/20 approach concentrate on common outpatient data Payloads specified down to coding systems e.g. SNOMED for problems Extensible representations in RDF iterative design, building models over time
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Data elements Sample SMART Problem (RDF) Backache (finding) 2007-06-12 2007-08-01
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Data principles REST Paradigm: Each patient, data element has a URI John Smith: http://smart-emr.hospital.org/records/123 John Smith’s atorvastatin: http://smart-emr.hospital.org/records/123/medications/456 URIs can map to underlying EMR IDs
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Data principles Consistent coding systems Medications: RxNorm (SCD, SBD, Packs) Problems: SNOMED CT Labs: LOINC Containers may need to translate from other terminologies, with provenance
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Data principles Consistent coding systems Example of a translated LOINC code Medications: RxNorm (SCD, SBD) Problems: SNOMED CT Labs: LOINC Containers may need to translate from other terminologies, with provenance Serum sodium Random blood sodium level <sp:translationFidelity rdf:resource="http://smartplatforms.org/terms/code/fidelity#automated" />
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Data principles Consistent coding systems Example of a translated LOINC code Medications: RxNorm (SCD, SBD) Problems: SNOMED CT Labs: LOINC Containers may need to translate from other terminologies, with provenance Serum sodium Random blood sodium level <sp:translationFidelity rdf:resource="http://smartplatforms.org/terms/code/fidelity#automated" /> source
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Data principles Consistent coding systems Example of a translated LOINC code Medications: RxNorm (SCD, SBD) Problems: SNOMED CT Labs: LOINC Containers may need to translate from other terminologies, with provenance Serum sodium Random blood sodium level <sp:translationFidelity rdf:resource="http://smartplatforms.org/terms/code/fidelity#automated" /> source SMART translation
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Data challenges Different coding systems e.g. for medications, NDC RxNorm e.g. for problems, ICD9 SNOMED CT (?) Different models e.g. is a problem event-at-a-time, or duration? No models – can’t expose data you don’t have. (but some may be worth storing, e.g., fulfillments)
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SMART governance Open specifications, documentation Open-source reference implementation Open-source client libraries Apps and Containers needn’t be open-source (promote a commercial ecosystem)
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Translation / Integration efforts CHB’s Cerner OpenMRS HealthVault, Indivo i2b2 Exploring Extended data models Integration of CDS Mobile apps + containers Ongoing projects
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Cross-SHARP sharing of: sample data logical models Collaboration around integrating SHARPN functionality as SMART apps (e.g. CTAKES pilot) extracting patient record data Other opportunities? Discussion topics!
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Questions?
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Container UI
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Health IT systems have different authentication mechanisms! How to keep apps agnostic? Each container implements a consistent mechanism for delegating access: OAuth. The app only needs to speak OAuth. Authentication
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App distribution model?
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Light, test-driven certification as SMART Independent groups may endorse apps Individual containers install selected apps (local arrangements, e.g. contractual terms)
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App distribution model?
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